Mothers’ Reports of Postpartum Pain Associated with Vaginal and Cesarean Deliveries: Results of a National Survey

ABSTRACT: Background: As cesarean rates increase worldwide, a debate has arisen over the relationship of method of delivery to maternal postpartum physical health. This study examines mothers’ reports of their postpartum experiences with pain stratified by method of delivery. Methods: Listening to Mothers II was a survey of a total of 1,573 (200 telephone and 1,373 online) mothers aged 18 to 45 years, who had a singleton, hospital birth in 2005. They were interviewed by the survey research firm, Harris Interactive, in early 2006. Online respondents were drawn from an existing Harris panel. Telephone respondents were identified through a national telephone listing of new mothers. Results were weighted to reflect a United States national birthing population. Mothers were asked if they experienced any of eight postpartum conditions and the extent and the duration of the problem. Responses were compared by method of delivery. Results: The most frequently cited postpartum difficulty was among mothers with a cesarean section, 79 percent of whom reported experiencing pain at the incision in the first 2 months after birth, with 33 percent describing it as a major problem and 18 percent reporting persistence of the pain into the sixth month postpartum. Mothers with planned cesareans without labor were as likely as those with cesareans with labor to report problems with postpartum pain. Almost half (48%) of mothers with vaginal births (68% among those with instrumental delivery, 63% with episiotomy, 43% spontaneous vaginal birth with no episiotomy) reported experiencing a painful perineum, with 2 percent reporting the pain persisting for at least 6 months. Conclusions: Substantial proportions of mothers reported problems with postpartum pain. Women experiencing a cesarean section or an assisted vaginal delivery were most likely to report that the pain persisted for an extended period. (BIRTH 35:1 March 2008)     

Nutritional status and wound severity of overweight and obese patients with venous leg ulcers: A pilot study

Obesity is a chronic disease that is linked to the presence of numerous chronic illnesses, including venous disease. Venous disease can lead to chronic wounds, which may be exacerbated by vitamin, mineral, and macro-nutritional deficiencies. A cross-sectional observational design was used to examine the nutritional status of patients with chronic venous leg ulcers (VLUs) who are overweight or obese and to explore the relationship between nutritional status and severity of venous ulceration. Nutritional status was evaluated using anthropometric measurements, nutrient analysis from a 3-day dietary intake log, serum albumin, vitamins A and C, and zinc levels. Wound severity was assessed using the Leg Ulcer Measurement Tool (LUMT). Eight patients participated; six patients were men, and all eight patients were more than 50 years of age. Patients had an average daily caloric intake below their estimated caloric need. When compared with recommended daily intake levels, dietary nutrient intake was suboptimal for protein, vitamin C, and zinc. Serum levels were below normal for at least one of these nutrients in six patients. A positive correlation was found only between serum albumin, average daily intake, and percent recommended daily intake of protein (r(s) = 0.93, P = .003). An inverse relationship was found between LUMT score and serum vitamin A levels (r(s) = -0.83, P = .01), and a positive correlation was observed between LUMT score and serum vitamin C (r(s) = 0.74, P = .04). No clear relationships were shown among serum zinc, albumin, and LUMT scores. Overweight and obese patients with VLU show nutritional deficits that are similar to those of the broader population of patients with leg ulcers. The relationships found between vitamins A and C and leg ulcer severity warrant further exploration. The nutritional differences in the study need to be examined in a larger sample of overweight and normal-weight patients to determine whether overweight patients are at greater risk for prolonged VLU because of poor nutrition than non-overweight patients.     

Postpartal Nursing Diagnosis

The responsibility of nurses for postpartal patients has changed greatly in the past few years. No longer is it adequate to assess and manage only those physical problems that occur during the hospital stay. Today, potential psychosocial problems and consequences of parental knowledge deficit are part of nursing's domain of diagnosis and management. A review of the purpose of nursing diagnosis is important. Clarifying the difference between medical diagnosis and nursing diagnosis is also essential if one is to be comfortable with the process. Careful scrutiny of the unique needs of new parents will form the basis for formulating meaningful postpartal nursing diagnosis.     

Personality hardiness, ways of coping, social support and burnout in critical care nurses

Hardiness, ways of coping, social support and burnout in 103 critical care nurses were addressed in this study. Work-related and nonwork-related social support and hardiness were negatively related to burnout. Use of emotion-focused coping was positively correlated with burnout while hardiness was negatively related to the use of emotion-focused coping and positively related to both types of social support. After controlling for working nights, social support, hardiness, emotion-focused coping and problem-focused coping accounted for 44% of the variance in burnout scores.     

The Inside Story: A Simulation Game on Ethical, Legal, and Political Decision Making in Health Policy for Nurse Practitioners

This game can be conducted with as many as 50 and as few as 15 players. The optimum size includes 4-5 Board members and 4-6 participants in each of the four small-group scenarios. The game takes about 11/2-2 hours to play. This includes a break between Part I and Part II. Existing state and national laws and policies are used in the game so that participants may understand their effects and limitations. The game has no winners or losers. Everyone gains if the decision markers are able to consider the needs of the individuals and the needs of the public, though some individuals may or may not benefit as much as others. This, however, is reality and is inherent in the policy-making process. In primary care, nurse practitioners (NPs) have a crucial responsibility to weigh the impact of their decisions on their clients and the community. The "Inside Story" integrates recommended NP curriculum content such as ethical decision making and health policy into a creative and powerful educational experience. This simulation game could be adapted for other topics with ethical, legal, and political implications such as issues regarding allocation of scarce resources. It could be played among students or professionals from many disciplines as part of their curriculum or in a continuing education offering.     

King's Framework and Theory in Japan, Sweden, and the United States

In this article, we present our work in extending and testing Imogene King's conceptual framework and theory in Japan, Sweden, and the United States. Comparing and contrasting cultural relevance, methodology, and issues of validity provide examples of international scholarship and knowledge development that result from networking and collaboration.